Thursday, May 13, 2010

Dialogue on Diarrhea


After my suturing adventure, I tried to limit my medical excursions. Despite my reluctance, I was occasionally called to help with something when there were no other resources. This was very ironic, as I barely knew what to do with simple medical cases. In the course of these "house calls" I learned far more than I wanted to about malaria, thyphoid, dysentery and female circumcision.
I had heard about female circumcision, but I considered it an antiquated practice. I would come to discover that there was a small sect of people in the camp that not only practiced it, but also infibulation (sewing the vagina nearly shut). It was very late one evening when one of my students came into my tent, obviously in distress. He looked about at his feet and stammered something in Afar. Eventually, we switched to a mixture of English and Arabic, and he let me know he wanted me to come with him, but we had to be very careful. We crept through the camp to a shack on the outskirts. He carefully surveyed the area, then whisked me through the cloth doorway. In the dimly lit room, I saw a young girl laying on a cot, moaning softly. There were a few other students in the room, and they were very frightened. They wanted me to help, and I knew something was wrong as it was very late, and there were no adults present. I sat down near the girl, and began to ask the other girls questions. I asked how long she had been sick, if she had seen a doctor, if she had a fever. She was covered with some thin material, and I knew I wouldn't be allowed to examine her too closely. I knew the problem was in her pelvic area, and I tried to get as close to her as I could without touching her. When I moved closer, I smelled the infection. I could also see some "projections" sticking up from her crotch, poking up into the cloth. She was incoherent, and I knew she was in dire trouble.
I told the students to stay with her, and I raced to the nearby village. A young female Sudani doctor had recently arrived in the village, and I thought this was a good time to make her acquaintance. I stopped and recruited a friend, a Sudani teacher, and we woke her up. At first she was reluctant (the refugees could never pay for medical service, and she would be looked down upon if she started to treat them). She finally agreed to come to the camp to see the girl. I was not allowed to go back into the room with the doctor, as a matter of fact, I was directed to go back to my shack. I was told the girl was taken to the regional hospital the next day, but she never returned. I am sure she died. Later, the translated story was that she had been sewn with some sort of thin grass, and that her family didn't want the officials to know. I was never allowed to know her name.
The first death I witnessed was that of a baby. I learned the child had died of dehydration. The camp had no running water (only salty wells), no electricity, and very few sources of fuel for fires and sterilization. Because of the heat, humidity, and poor hygienic conditions, the children were often sick. Malaria took its share, but more children suffered and died from dysentery and diarrhea. It is an eerie thing to push your finger into a child's belly, and not to see the skin spring back. After the first death, and the rumor of a second, I took a trip to a large town four hours to the north, and met with some Russian doctors I had met. They explained rehydration therapy to me, and gave me a copy of a newsletter, Dialogue on Diarrhea. I returned to the camp with a new mission - sanitation and education.
I met with the elders and told them I wanted to hold some classes for women in the new school. I showed them the tools I would use (liter cups, bottle caps, salt, and sugar). I bought enough sugar and salt to start the project, and an eager Yemeni shop keeper provided the bottle caps. Slowly, the mothers came forward and I, with the help of some of the early converts, showed them how to clean the water vessels and mix the rehydration solution in proper ratios. The students pitched in and made some posters with instructions written and drawn. And although I couldn't get them to boil all their water (there simply was not enough fuel), they did boil some communal water for mothers with young babies. It was a wonderful campaign.
Later, I turned my attention to the large garbage pits surrounding the camp. We found some large metal cans, and got most everyone to deposit hypodermics and other sharp metals into them. The older students patrolled the camp and picked up anything that was dangerous or unhealthy.
It wasn't that the refugees weren't aware of many of these issues, they were just so preoccupied with survival and day to day needs that they neglected them. Also, there was no designated person or official to monitor them. I was very pleased that once we started attending to the issues, the refugees (particularly the women and children) took charge. And I gained a new favorite literary source - the Russian doctors began to forward their bimonthly journal, Dialogue on Diarrhea to me. I was excited each time I got a copy.

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